GREEN ARCHITECTURE PROVIDING A WHOLE NEW

EXPERIENCE OF SAFE RECOVERY- PROF (DR) R. CHANDRASHEKHAR

What is Medical Architecture and how it is different from normal architecture? This is a question that is often asked whenever we hear this term. In Medical Architecture, one has to have a comprehensive approach in terms of infrastructure, medical equipment, and manpower, whereas in general architecture, a Design brief is provided on that basis the infrastructure is designed. A hospital is incomplete if either one of them is missing. Therefore, a comprehensive approach is required and a due focus should be given to sustenance as well. Green-hospital or sustainable architecture includes a comprehensive thought process. So medical architecture is synergizing requirements of various stakeholders to design functional, cost effective, patient centric and staff centric healthcare infrastructure with optimum utilization of available space.

A hospital design, besides patient centric should also be staff centric, if the staffs are stressed, it ultimately affects the patient’s recovery. Many studies have proved that by virtue of efficient functional planning, the reduced travel distance of the doctor and nurses within hospital increases their efficiency, as their daily routine with clinical activities involves long walk within hospital.

The ultimate focus of a Green-Hospital is the speedy recovery of patient and the hospital architecture with Evidence Based Design connects patient with mother nature, increased day light and natural ventilation supports a patient for speedy recovery. Evidence based healthcare architecture creates safe and therapeutic environment for patient care and encourages family involvement. It promotes efficient staff performance and is restorative for workers under stress. It allows health facilities professionals to use scientific research to plan, design, construct, and operate healthcare facilities that are geared towards promoting not only treatment but more conducive healing and working environment. Such evidence will also allow Hospital design and construction to be flexible, adaptable and future ready.

Environmental comfort can be thru improved Indoor Air Quality (IAQ) with well designed ventilation system and air filters to prevent Nosocomial infection. Appropriate selection of material and specifications and scrupulous hand washing can substantially lower infection rates in hospital.

It is also important to use a soundabsorbent ceiling and flooring to reduce noise which will lower the stress level of patients and staff alike. It was proved that in the hospitals with the lower noise level, had patients more satisfied with their care, slept better, at lower blood pressure, and are less likely to be rehospitalized and similarly the staffs also find better job satisfaction and improved sleep quality. Right layout and detailing also reduce the Patient falls, which often occurs while trying to reach the bathroom at night. Design a better Wayfinding for spatial legibility. Good signage to reach the correct destination is also helpful as often it is noticed that the people tend to get confused in a hospital, proper signage will help in reducing such confusion.

Nursing stations are quite hectic and stressful and has chances of errors too. So, with a well-lit space organized around critical activity area can help in reducing medication errors and also decreases the stress level of the nurses and physicians.

Researches are claiming that the spinal cord surgery recovery patients on the brighter side of the unit perceived lower stress, less pain, and took 22 % less analgesic medication per hour, incurred 21% less pain medication cost. Similarly, the patients suffering from Bipolar disorder and Seasonal Affective Disorder (SAD) in the east-facing room stayed 3.67 days less as compared to the other patients in the west-facing room and these research outcomes are extensively used for healthcare design. It was also found that morning light is much more effective in treating patients with depression than evening light exposure.

Even the cycled light in the Neonatal Intensive Care Unit, the patients experienced improved sleep, greater rate of weight gain, able to be fed orally sooner, fewer days in ventilator, fewer days on phototherapy. Cycle light is reduced light level in the night, and noncycle light is constant light during day and night. Therefore, the Evidence-Based Design which is also known as Healing Architecture creates a comfortable environment and helps in retaining the ability to keep patients secure. It is also important to make sure that every patient is connected to nature. The ward design based on Evidence-Based Design also worked very well in COVID wards where a safe distancing is required. Ideally to reduce the infection, every patient is preferred to be kept in an independent room. But this may not be costeffective as it is directly related to number of supporting nursing staff. The figure illustrates in a general ward, Evidence Based Design ward having independent Bed space, having window at bedside connecting with nature, courtyard with

cross ventilation and ample day light, having healing environment helping in speedier recovery. An architect must adopt Passive Architecture design features to minimize negative environmental impact, such as passive cooling/heating technology, Climate responsive concepts and design in terms of orientation etc. A healing garden in roof and terraces of the hospital, enhances patient, visitor, and staff experience and also helps in saving energy, reduces noise level , mitigation of urban heat island effect, Rainwater management and increases roof life. Use of Photo Voltaic (PV) solar panels on roof is an efficient means of energy generation.

IGBC (Indian Green Building Council) has a unique Healthcare rating system and it emphasizes following elements•

Indoor Environment Quality ( Indoor Air Quality, Infection control & Evidence Based Design)

• Sanitisation & Hygiene

• Water Conservation

• Energy efficiency

• Building Material and Resources

• Site selection and planning.

During site selection, a few parameters have to be kept in mind, primarily the location, and its geological phenomenon. Master planning strategies are also very important. While planning, every design should have a planned zone for future growth. The concept of Loose fit design, is to design larger spaces that can be used for more than the minimum function originally proposed and the design that supports easy changes and conversion. It is also recommended to use Adaptable flexibility that means spaces can be designed to adapt to multiple uses and planned to serve range of possibilities and should also have Convertible flexibility, with low space, time and cost, Space can be converted into other uses. That's how during the pandemic the number of COVID wards were converted into critical care.

Day Space in a ward is right example of flexible use. It is multipurpose space for patients and also relatives meeting place, and during disaster the same become refuge area and Solarium whenever required.

In order to offer flexibility in design, the utility and communication infrastructure of a health care facility should be capable of expansion and upgrade. Availability of utility and network capacity simplifies and dramatically reduces the cost of future projects.

During the COVID Pandemic, we experienced the importance of infection control and we are at greater risk to be affected with the air borne infections. The various technological method in use to reduce the risk of airborne infection, are –

• Pressurization- negative pressure in an isolation room with respect to surrounding, or Positive pressure in procedure room with respect to surrounding,

• Dilution- where there is high ventilation rate,(ACPH) Air changes per hour, controls particle by removal through ventilation.

• Filtration- the use of various kinds of air filters, such as Prefilter, MERV, HEPA Filters etc.

• Purification- you may trap all the pathogens by filtration but the filter can’t destroy them, hence filter bank becomes colony of pathogens, so it is necessary to destroy them by exposing them to UV radiation or ionization or various other methods available.

Most infections that become clinically evident after 48 hours of hospitalization are considered hospital-acquired. The studies have also shown that 80 per cent of infection spreads through touch surfaces i.e. door handles, Grab bar, bed rail, IV Fluid stand etc. Antimicrobial Copper is the most effective touch surface material, killing greater than 99% of bacteria within two hours of exposure. Copper and copper alloys have intrinsic antimicrobial properties with well documented efficacy against a wide range of pathogens.

Safety of the patient is equally given importance, hence every hospital should be ready with disaster preparedness and should have Evacuation Plan. Hospital design should blend open spaces and built spaces, indicating fire escape route, provision of refuge area for easier evacuation in multistoried structures, displaying appropriate signages displaying evacuation route in different parts of the building.

A patient wants a built environment that promotes connection with the staff, conducive to well-being, convenient and accessible, should be confidential and private, shows caring for family, is considerate for impairment and facilitates connection to the outside world, and is safe and secure. The built environments enhance patient flow, overall efficiency, and functional operation in a healthcare facility.

The present government In the recent budget has given focus on Healthcare and wellbeing by increasing its share almost 137% which is a quantum jump to meet the healthcare infrastructure needs.

Green smart Hospitals are the need of the hour and IGBC Green healthcare rating addresses exactly the same. Government has already started Green certification as mandatory in government projects.

So the ultimate aim is GO GREEN and create healing environment for patient and staff alike.